Balance (Vestibular) Disorders

small child concentrating

Kids stumble and fall sometimes, especially toddlers. However, if you're seeing a pattern of possibly balance-related symptoms (dizziness, falling, blurred vision, disorientation or nausea) — find out what's going on. The Nemours Balance Disorders Program provides a unique and effective way to evaluate, diagnose and care for children with balance and vestibular (inner ear balance) disorders.

 
Read More About Vestibular Disorders

In our state-of-the art center for pediatric vestibular testing we are able to perform specialized testing in labs where we can stimulate the inner ear and see how balance and gross motor skills (that is, movement of the large muscles) are affected. We believe that our comprehensive approach has allowed us a high rate of success in identifying and managing children with a variety of vestibular disorders.

A balance disorder may be caused by the pathology (problem) of the labyrinth, which is an organ of the body located in the inner ear, consisting of three semicircular canals and the vestibule. The labyrinth interacts with the eyes, muscles, and joints to maintain the body’s position. This system, along with the brain and the nervous system, can be the source of balance disorders.

Balance disorders can be traced to four key areas:
  • Peripheral vestibular disorder, a disturbance in the vestibule
  • Central vestibular disorder, a problem in the brain or its connecting nerves
  • Systemic disorder, a problem in the body other than the head and brain
  • Vascular disorder or blood flow problems

Nemours Children's Hospital, Orlando


13535 Nemours Parkway
Orlando, FL 32827
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For Appointments: (407) 650-7715
Hours: Monday–Friday, 8 a.m. to 5 p.m.

 
What to Bring
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
  • prior audiology, otolaryngology and/or screening reports
New Patients

Bring these forms for your first appointment:

Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
 
Forms & Resources
New Patient Forms
Returning Patient Forms
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
Resources for Patients & Families

The pediatric specialists at Nemours Children’s Hospital in Orlando use state-of-the-art technology and the latest testing techniques to evaluate, diagnose and treat children with balance and vestibular (inner ear balance) problems. To better serve children and families throughout Central Florida, many of our otolaryngologists (ear, nose and throat, "ENT" specialists), neurotologists and audiologists (hearing) specialists also see kids at our specialty care locations in downtown Orlando, Lake Mary and Melbourne

Learn More About Pediatric Otolaryngology Services at Nemours Children’s Hospital »

Multispecialty Pediatric Care for Balance (Vestibular) Disorders

Our bodies rely on three separate systems for balance: neurological (the nervous system), auditory (hearing) and vestibular (balance). 

To pinpoint the cause of your child’s balance problems, our board-certified otolaryngologists work closely with other internationally recognized Nemours specialists. Once they find the cause, they customize an effective treatment to improve your child’s comfort and quality of life.

 
Types of Balance Disorders We Treat

The most frequently diagnosed vestibular conditions include:

  • benign paroxysmal torticollis of infancy (condition marked by a tilted head from feeling dizzy)
  • benign paroxysmal vertigo of childhood, or "BPV"(sometimes called childhood paroxysmal vertigo caused by fluid or tiny particle build-up in the inner ear)
  • vestibular neuritis (an infection that causes inflammation of the vestibular nerve)
  • labyrinthitis (can be caused by an infection of the part of the inner ear, the labyrinth, that controls balance)

Other balance problems include:

  • ototoxicity (caused by medications that destroy the hair cells in the inner ear responsible for sending balance signals to the brain)
  • Ménièr disease (caused by an imbalance of inner ear fluid)
  • peripheral disorders (such as perilymph fistula and enlarged vestibular aqueduct syndrome)
 
Your Child’s Balance Disorder Care Team

In addition to pediatric otolaryngologists, neurotologists, otologists and audiologists, Nemours balance disorder care teams may also include:

Balance Disorder Signs and Symptoms in Children

Kids with balance disorders often feel unsteady or "woozy," which makes it hard to stand up, walk or turn corners. They may also:

  • have trouble climbing stairs without falling
  • bump into things, stumble or trip
  • walk with their legs too far apart
  • stagger when walking
 
Common Symptoms of Vestibular Disorders

Symptoms of a balance problem may include:

  • vertigo (a rocking, floating or "on a merry-go-round" feeling, and/or feelings of dizziness, lightheadedness or disorientation)
  • oscillopsia (vision disturbances like bouncing or blurriness, difficulty reading and writing)
  • nystagmus (involuntary eye movements)
  • hearing problems (muffled sounds, ear pain, ear pressure or "fullness", ringing in the ear)
  • discomfort or difficulty looking at sun glare or lights, especially fluorescent, flashing or moving lights
  • discomfort in situations with "busy" visuals like patterns, crowds, heavy traffic and jam-packed areas like shopping malls
  • trouble with depth perception and disruptions that can affect hand-eye or eye-foot coordination (which can make it hard to do things like catch or kick a ball)

Nemours Children’s Hospital specializes in providing unique and effective way to evaluate, diagnose and care for children with balance or vestibular disorders.

 
Causes of Balance Problems in Kids

Balance-related symptoms may be brought on by any number of things, such as:

  • ear, head or neck injuries
  • migraines
  • hearing loss
  • immune-deficiency disorders
  • metabolic disorders
  • neurological disorders
  • vascular insufficiencies
  • chronic middle ear infections (otitis media)
  • other infections (cold, flu, meningitis, measles, mumps or rubella)
  • depression
  • motion sickness or sensitivity
  • seizure disorders

Children who have a family history of hearing or vestibular problems, dizziness or motion sickness might also be more prone to balance disorders.

 
The Relationship Between Balance and Hearing

The ear houses both an auditory system (for hearing) and a vestibular system (for balance). These two systems, which are about the size of a dime, are connected. If a problem occurs in one area, it may also affect the other.

In some kids, a balance problem may lead to hearing loss (either temporary or permanent). And in others, hearing loss may be recognized first and then a balance problem may be discovered. Studies show that up to 30 percent of children with permanent hearing loss may also experience a balance problem, and about 10 percent of kids with a vestibular problem also have hearing loss.

Learn More About These and Other Children’s Health Topics at Nemours KidsHealth.org »

Diagnosing Balance Disorders in Children

Balance problems in children are difficult to diagnose because the symptoms often go unnoticed or are mistaken for typical childhood behavior. At Nemours Children’s Hospital, our collaborative team uses the latest equipment and evaluation methods to diagnose vestibular disorders of all kinds. Our licensed specialists have extensive experience working with children of all ages with special needs.

In addition to basic hearing tests, we conduct auditory balance testing in a lab where we can stimulate the inner ear to see how your child’s balance is affected. Testing is customized to your child’s age and developmental abilities. Medical imaging tests such as MRI, CT or "CAT" scans may also be ordered.

Comprehensive vestibular testing is scheduled as a panel appointment — this means your child will receive evaluations in otolaryngology, audiology and other specialists on the same day. The entire vestibular evaluation will last about five to six hours, with many breaks throughout.

Treating Pediatric Balance (Vestibular) Disorders

Treating balance disorders can help kids function and feel better. There are many management options for treating balance disorders in children, and they vary depending on the underlying cause of the symptoms. Every child is unique, and our main goal is to maximize your child’s ability to fully and comfortably participate in activities of daily living.

 
Treatment Options for Balance Disorders in Children

Depending on your child’s condition, we may recommend:

  • dietary changes
  • medications (anti-nausea drugs, antibiotics, corticosteroids)
  • vestibular rehabilitation therapy or "VRT" (exercises that help with balance, reflexes, eye movement control, etc.)
  • surgery